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General NPI Number Information
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NPI Number | 1063064343
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTERS
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 716 1ST AVE S
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City | OKANOGAN
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State | WA
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Zip | 98840-9679
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Country | US
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Telephone | 509-422-6705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | OKANOGAN
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State | WA
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Zip | 98840-1340
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Country | US
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Telephone | 509-422-8632
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Fax | 509-422-8632
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Authorized Official
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Title or Position | CEO
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Name | JESUS HERNANDEZ
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Credential |
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Telephone | 509-422-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223X0008X
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Taxonomy Name | Oral and Maxillofacial Radiology Dentistry
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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